Provider Demographics
NPI:1760965198
Name:FOFUNG, ANNA BANNI (NP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:BANNI
Last Name:FOFUNG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12875 MORNINGPARK CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7329
Mailing Address - Country:US
Mailing Address - Phone:678-943-7371
Mailing Address - Fax:
Practice Address - Street 1:12875 MORNINGPARK CIR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-7329
Practice Address - Country:US
Practice Address - Phone:678-943-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139796363LF0000X
GARN216436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily